Medication Side Effects – Cause For Concern

By Morvarid Karimi, MD
Washington University School of Medicine, Movement Disorders Section

“My mother was doing fine and underwent a simple elective surgery but came back as stiff as a board and could never walk again.” This is not a rare report and can be blamed on a single dose of a medication that should not be given to PD patients. It can be as simple as a nausea medication. It is not unusual to have nausea related to narcotic intake which is much needed for pain after a surgery. Many times patients become restless and disoriented as a side effect of narcotics or just being in a new environment and the medication given to calm them (an antipsychotic) is to be blamed. The list of such harmful medications for PD is long. They all have dopamine antagonistic properties which in simple words deteriorates what is already defective in PD. Unfortunately the detrimental effect is at times irreversible. Most physicians and pharmacists are aware of the worst offenders (Haldol and typical antipsychotics), but the harmless appearing antiemetics (nausea medications) can be easily overseen. Of a greater concern is the ever growing list of so called atypical antipsychotics which are claimed by the pharmaceutical companies to have a lesser effect on the dopamine receptors and hence safer to use in PD. Our collective experience at the Movement Disorder Center is that newer antipsychotics (with exception of Seroquel® and Clozaril®) worsen the PD symptoms. There are numerous case reports of worsening PD symptoms for almost all these atypical antipsychotics in the literature, as well. More reliably there are double-blinded, placebo-controlled studies for a few of these drugs demonstrating worsening PD symptoms in an objective way. It is most concerning that these medications are increasingly used not to treat the notorious PD hallucination and psychosis but rather depression thanks to aggressive campaigning of the pharmaceutical companies. Both hallucination and depression associated with PD can be difficult to treat. Only one atypical antipsychotic (Clozaril®) has been proven to treat PD hallucination and psychosis effectively without worsening the PD symptoms. There has not been a single scientific study to show that this group of medication is effective in treating PD related depression and we already know about the side effects. It is up to the PD patients and their family to be watchful and to avoid these medications. Some of these have a standing order in hospitals and nursing homes. Hence we advocate listing these medications as their allergy when PD patients are admitted to the hospital or nursing home to guarantee that these harmful medications are avoided.

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